scholarly journals Two-Arm Robotic-Assisted High Anterior Resection: a Cost-Effective Way to Perform Robotic Surgery

2021 ◽  
Author(s):  
Vivek Sharma ◽  
Thusitha Hettiarachchi ◽  
Dhiraj Sharma ◽  
Irshad Shaikh
Keyword(s):  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Colorectal Surgery ◽  
Anterior Resection ◽  
Cost Effective ◽  
Robotic Assisted ◽  
Novel Method ◽  
Standard Laparoscopic Surgery ◽  
The Cost ◽  
Disposable Equipment

AbstractIn the era where laparoscopic colorectal surgery is well established, robotic- assisted colorectal surgery is gaining increasing popularity and acceptability. Stable camera platform, superior 3D views, and articulating instruments help to overcome difficulties associated with standard laparoscopic surgery. However, a significant drawback of robotic surgery is the cost of the robotic system and relevant disposable equipment compared to conventional laparoscopic surgery. This image series depicts a novel method to perform laparoscopic high anterior resection in a more cost-effective way.

Use, Cost, Complications, and Mortality of Robotic versus Nonrobotic General Surgery Procedures Based on a Nationwide Database

2013 ◽  
Vol 79 (6) ◽  
pp. 553-560 ◽  
Author(s):  
Muhammad Salman ◽  
Theodore Bell ◽  
Jennifer Martin ◽  
Kalpesh Bhuva ◽  
Rod Grim ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Length Of Stay ◽  
General Surgery ◽  
New Technology ◽  
Cost Effective ◽  
Robotic Assisted ◽  
Setup Costs ◽  
Lengths Of Stay ◽  
Surgeon Training ◽  
The Cost

Since its introduction in 1997, robotic surgery has overcome many limitations, including setup costs and surgeon training. The use of robotics in general surgery remains unknown. This study evaluates robotic-assisted procedures in general surgery by comparing characteristics with its nonrobotic (laparoscopic and open) counterparts. Weighted Healthcare Cost and Utilization Project Nationwide Inpatient Sample data (2008, 2009) were used to identify the top 12 procedures for robotic general surgery. Robotic cases were identified by Current Procedural Terminology codes 17.41 and 17.42. Procedures were grouped: esophagogastric, colorectal, adrenalectomy, lysis of adhesion, and cholecystectomy. Analyses were descriptive, t tests, χ2s, and logistic regression. Charges and length of stay were adjusted for gender, age, race, payer, hospital bed size, hospital location, hospital region, median household income, Charlson score, and procedure type. There were 1,389,235 (97.4%) nonrobotic and 37,270 (2.6%) robotic cases. Robotic cases increased from 0.8 per cent (2008) to 4.3 per cent (2009, P < 0.001). In all subgroups, robotic surgery had significantly shorter lengths of stay (4.9 days) than open surgery (6.1 days) and lower charges (median $30,540) than laparoscopic ($34,537) and open ($46,704) surgery. Fewer complications were seen in robotic-assisted colorectal, adrenalectomy and lysis of adhesion; however, robotic cholecystectomy and esophagogastric procedures had higher complications than nonrobotic surgery ( P < 0.05). Overall robotic surgery had a lower mortality rate (0.097%) than nonrobotic surgeries per 10,000 procedures (laparoscopic 0.48%, open 0.92%; P < 0.001). The cost of robotic surgery is generally considered a prohibitive factor. In the present study, when overall cost was considered, including length of stay, robotic surgery appeared to be cost-effective and as safe as nonrobotic surgery except in cholecystectomy and esophagogastric procedures. Further study is needed to fully understand the long-term implications of this new technology.

scholarly journals Robotic rectosigmoidectomy: pioneer case report in Brazil. Current scene in colorectal robotic surgery

2010 ◽  
Vol 47 (1) ◽  
pp. 116-118 ◽  
Author(s):  
Marcelo Averbach ◽  
Pedro Popoutchi ◽  
Oswaldo Wiliam Marques Jr ◽  
Ricardo Z Abdalla ◽  
Sérgio Podgaec ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Colorectal Surgery ◽  
Colorectal Resection ◽  
Deep Infiltrating Endometriosis ◽  
Brazil Current ◽  
Current Series ◽  
Robotic Colorectal Surgery ◽  
Rectal Involvement ◽  
Surgical Device ◽  
Standard Laparoscopic Surgery

Laparoscopic colorectal surgery is believed to be technically and oncologically feasible. Robotic surgery is an attractive mode in performing minimally-invasive surgery once it has several advantages if compared to standard laparoscopic surgery. The aim of this paper is to report the first known case of colorectal resection surgery using the robotic assisted surgical device in Brazil. A 35-year-old woman with deep infiltrating endometriosis with rectal involvement was referred for colorectal resection using da Vinci® surgical system. The authors also reviewed the most current series and discussed not only the safety and feasibility but also the real benefits of robotic colorectal surgery

Nep-Endotrainer: A cost-effective home-made laparoscopic simulation tool

2021 ◽  
Vol 23 (2) ◽  
pp. 52-55
Author(s):  
Uttam Laudari ◽  
Deepak Mahat ◽  
Rosi Pradhan ◽  
Suyog Bhandari ◽  
Deepak Raj Singh
Keyword(s):  
Laparoscopic Surgery ◽  
Mobile Phones ◽  
Cost Effective ◽  
Simulation Tool ◽  
Drilling Machine ◽  
Web Camera ◽  
The Cost ◽  
Training Modules ◽  
Established Treatment ◽  
The Web

Introduction: Laparoscopic surgery is an established treatment modality worldwide. Opportunities to acquire this skill using expensive simulation at workplace are not always feasible due to cost, time and accessibility constraints. Nep-Endotrainer is a cost effective homemade laparoscopic simulation tool built in Nepal. Methods: Nep-Endotrainer was built using plastic manikins easily available in market. Nine apertures were created with a drilling machine, four on each side of umbilicus and one at the epigastric region. These apertures were covered by thick piece of rubber of vehicle tire with apertures in them. Logitech® C270 HD webcam was fixed interiorly with metal screws. The base of the manikin was fixed to a wooden board with hinge joint. Five different interchangeable training modules were assembled in 10×10 cm2 size wooden boards. The LED light was fixed interiorly near the web camera. The camera USB can be easily connected with laptops, tablets and mobile phones. We used discarded hand instruments from laparoscopic centers to reduce the cost of the endotrainer. Conclusion: Nep-Endotrainer is accessible to any personal budget and can be readily constructed. It allows more frequent practice at home, outside the venue and hours of surgical departments.

scholarly journals Robotic-Assisted vs. Standard Laparoscopic Surgery for Rectal Cancer Resection: A Systematic Review and Meta-Analysis of 19,731 Patients

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 180
Author(s):  
Kamil Safiejko ◽  
Radoslaw Tarkowski ◽  
Maciej Koselak ◽  
Marcin Juchimiuk ◽  
Aleksander Tarasik ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Laparoscopic Surgery ◽  
Survival Rate ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Overall Survival Rate ◽  
Cancer Resection ◽  
Robotic Assisted ◽  
Standard Laparoscopic Surgery

Robotic-assisted surgery is expected to have advantages over standard laparoscopic approach in patients undergoing curative surgery for rectal cancer. PubMed, Cochrane Library, Web of Science, Scopus and Google Scholar were searched from database inception to November 10th, 2021, for both RCTs and observational studies comparing robotic-assisted versus standard laparoscopic surgery for rectal cancer resection. Where possible, data were pooled using random effects meta-analysis. Forty-Two were considered eligible for the meta-analysis. Survival to hospital discharge or 30-day overall survival rate was 99.6% for RG and 98.8% for LG (OR = 2.10; 95% CI: 1.00 to 4.43; p = 0.05). Time to first flatus in the RG group was2.5 ± 1.4 days and was statistically significantly shorter than in LG group (2.9 ± 2.0 days; MD=-0.34; 95%CI: −0.65 to 0.03; p = 0.03). In the case of time to a liquid diet, solid diet and bowel movement, the analysis showed no statistically significant differences (p > 0.05). Length of hospital stay in the RG vs LG group varied and amounted to 8.0 ± 5.3 vs 9.5 ± 10.0 days (MD = −2.01; 95%CI: −2.90 to −1.11; p < 0.001). Overall, 30-days complications in the RG and LG groups were 27.2% and 19.0% (OR = 1.11; 95%CI: 0.80 to 1.55; p = 0.53), respectively. In summary, robotic-assisted techniques provide several advantages over laparoscopic techniques in reducing operative time, significantly lowering conversion of the procedure to open surgery, shortening the duration of hospital stay, lowering the risk of urinary retention, improving survival to hospital discharge or 30-day overall survival rate.

scholarly journals IMPLEMENTATION OF GYN ROBOTIC SURGERY IN OUR PRACTICE

2020 ◽  
Vol 62 (2) ◽  
Author(s):  
Antony Brignoni ◽  
◽  
Oksana Mudra ◽  
Keyword(s):  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
High Precision ◽  
Gynecologic Surgery ◽  
Robotic Technology ◽  
High Definition ◽  
Robotic Assisted ◽  
Conventional Laparoscopic

Middle East has launched its first comprehensive robotic surgery programme, Known as one of the most sophisticated laparoscopic surgical technologies available, the device – created by Intuitive – is part of the new programme aimed at enhancing the group’s “current comprehensive general surgery and laparoscopic surgery services”. American Hospital was selected as the hub for this robotic programme as it is already considered a market leader in advanced laparoscopic surgery. According to the manufacturer, the da Vinci Xi HD 4 works by combining conventional laparoscopic techniques with high precision robotic technology that uses four robotic arms controlled by the surgeon from a console. Through the console, the surgeon is also able to access a 3D high-definition view of the surgical area. Robotic surgery is a state of the art surgical procedure in which the conventional laparoscopic technique is combined with high precision robotic technology. Articulated instruments allow the same movement capacity as the human wrist and the tremor filter eliminates any small uncontrollable movement in the surgeon's hands. We would like to share our experience in implementation of Robotic Assisted surgery in gynecological practice of out hospital. Commencement of our program coincided with very difficult period for all World. Regardless COVID pandemic, we started successfully our robo- surgical journey, and within 6 months we performed 150 Robotic assisted surgeries, 50 of them- gynecological. Gynecologic surgery has been transformed in the last three decades in the western world, from mostly open abdominal surgeries with increased length of stay and morbidity to today with minimally invasive surgeries with short length of stay, decreased morbidity, faster return to normal activities and work. Long past the days of doing laparoscopic surgery with direct viewing through a scope, later poor quality imaging monitors to our current High definition 2D and 3D imaging. In the last decade the introduction of Robotics to our surgical armamentarium has steadily increase the likelihood that patients will have minimally invasive procedure instead of an open laparotomy.

The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample

2018 ◽  
Vol 33 (7) ◽  
pp. 2217-2221 ◽  
Author(s):  
Zhamak Khorgami ◽  
Wei T. Li ◽  
Theresa N. Jackson ◽  
C. Anthony Howard ◽  
Guido M. Sclabas
Keyword(s):  
Laparoscopic Surgery ◽  
National Inpatient Sample ◽  
Robotic Assisted ◽  
The Cost

Cost-Effectiveness of Conventional vs Robotic-Assisted Laparoscopy in Gynecologic Oncologic Indications

2015 ◽  
Vol 25 (6) ◽  
pp. 1102-1108 ◽  
Author(s):  
Patricia Marino ◽  
Gilles Houvenaeghel ◽  
Fabrice Narducci ◽  
Agnès Boyer-Chammard ◽  
Gwenaël Ferron ◽  
...  
Keyword(s):  
Hospital Costs ◽  
Surgical Techniques ◽  
Cost Effective ◽  
Conventional Laparoscopy ◽  
Fixed Cost ◽  
Operating Theater ◽  
Robotic Assisted ◽  
Number Of Patients ◽  
The Cost ◽  
Robotic Assisted Laparoscopy

ObjectiveRobotic surgical techniques are known to be expensive, but they can decrease the cost of hospitalization and improve patients’ outcomes. The aim of this study was to compare the costs and clinical outcomes of conventional laparoscopy vs robotic-assisted laparoscopy in the gynecologic oncologic indications.MethodsBetween 2007 and 2010, 312 patients referred for gynecologic oncologic indications (endometrial and cervical cancer), including 226 who underwent conventional laparoscopy and 80 who underwent robot-assisted laparoscopy, were included in this prospective multicenter study. The direct costs, operating theater costs, and hospital costs were calculated for both surgical strategies using the microcosting method.ResultsBased on an average number of 165 surgical cases performed per year with the robot, the total extra cost of using the robot was €1456 per intervention. The robot-specific costs amounted to €2213 per intervention, and the cost of the robot-specific surgical supplies was €957 per intervention. The cost of the surgical supplies specifically required by conventional laparoscopy amounted to €1432, which is significantly higher than that of the robotic supplies (P < 0.001). Hospital costs were lower in the case of the robotic strategy (€2380 vs €2841, P < 0.001) because these patients spent less time in intensive care (0.38 vs 0.85 days). Operating theater costs were higher in the case of the robotic strategy (€1490 vs €1311, P = 0.0004) because the procedure takes longer to perform (4.98 hours vs 4.38 hours).ConclusionsThe main driver of additional costs is the fixed cost of the robot, which is not compensated by the lower hospital room costs. The robot would be more cost-effective if robotic interventions were performed on a larger number of patients per year or if the purchase price of the robot was reduced. A shorter learning curve would also no doubt decrease the operating theater costs, resulting in financial benefits to society.

scholarly journals Comparison between robotic-assisted and laparoscopic sphincter-preserving operations for ultra-low rectal cancer: a single institutional retrospective study

2021 ◽  
Author(s):  
Tadahiro Kojima ◽  
Hitoshi Hino ◽  
Akio Shiomi ◽  
Hiroyasu Kagawa ◽  
Yusuke Yamaoka ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Multivariate Analyses ◽  
Anal Verge ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery

Abstract Background Sphincter-preserving operations for ultra-low rectal cancer include low anterior resection and intersphincteric resection. In low anterior resection, the distal rectum is divided by a transabdominal approach, which is technically demanding. In intersphincteric resection, a perineal approach is performed. We aimed to evaluate whether robotic-assisted surgery is technically superior to laparoscopic surgery for ultra-low rectal cancer. The frequency of conducting low anterior resection by a specific procedure can indicate the technical superiority of that procedure for ultra-low rectal cancer. Thus, we compared the frequency of low anterior resection between robotic-assisted and laparoscopic surgery in cases of sphincter-preserving operations. Methods We investigated 183 patients who underwent sphincter-preserving robotic-assisted or laparoscopic surgery for ultra-low rectal cancer (lower border within 5 cm of the anal verge) between April 2010 and March 2020. The frequency of low anterior resection was compared between laparoscopic and robotic-assisted surgeries. The clinicopathological factors associated with an increase in performing low anterior resection were analyzed by multivariate analyses. Results Overall, 41 (22.4%) and 142 (77.6%) patients underwent laparoscopic and robotic-assisted surgery, respectively. Patient characteristics were similar between the groups. Low anterior resection was performed significantly more frequently in robotic-assisted surgery (67.6%) than in laparoscopic surgery (48.8%) (p = 0.04). Multivariate analyses showed that tumor distance from the anal verge (p < 0.01) and robotic-assisted surgery (p = 0.02) were significantly associated with an increase in the performance of low anterior resection. The rate of postoperative complications or pathological results was similar between the groups. Conclusions Compared with laparoscopic surgery, robotic-assisted surgery significantly increased the frequency of low anterior resection in sphincter-preserving operations for ultra-low rectal cancer. Robotic-assisted surgery has technical superiority over laparoscopic surgery for ultra-low rectal cancer treatment.

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